Provider Demographics
NPI:1528175072
Name:SHAH, JAYENDRA H (MD)
Entity type:Individual
Prefix:DR
First Name:JAYENDRA
Middle Name:H
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7449 N CALLE SIN DESENGANO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1203
Mailing Address - Country:US
Mailing Address - Phone:520-575-1746
Mailing Address - Fax:
Practice Address - Street 1:3601 S. 6HT AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AR
Practice Address - Zip Code:85723
Practice Address - Country:US
Practice Address - Phone:520-629-1815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21493207R00000X, 207RE0101X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine